Sequential gas delivery provides precise control of alveolar gas exchange

Of the factors determining blood gases, only alveolar ventilation (V˙A) is amenable to manipulation. However, current physiology text books neither describe how breath-by-breath V˙A can be measured, nor how it can be precisely controlled in spontaneously breathing subjects. And such control must be effected independent of minute ventilation (V˙E) and the pattern of breathing. Control of V˙A requires the deliberate partition of inhaled gas between the alveoli and the anatomical deadspace. This distribution is accomplished by sequential gas delivery (SGD): each breath consists of a chosen volume of 'fresh' gas followed by previously exhaled gas. Control of V˙A through SGD is a simple, inexpensive, yet powerful tool with many applications. Here we describe how to implement SGD, how it precisely controls V˙A, and consequently how it controls arterial blood gases.